Xie Jingui, Cheng Guang, Zheng Zhichao, Luo Haidong, Ooi Oon Cheong
The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
School of Management, University of Science and Technology of China, Hefei, China.
J Card Surg. 2019 Oct;34(10):1004-1011. doi: 10.1111/jocs.14189. Epub 2019 Aug 2.
Extubation is a critical step in the intensive care unit (ICU). In this study, we aim to investigate the risk factors for both extubation failure and deterioration with further mechanical ventilation (MV).
Data were collected from a cardiothoracic ICU in a tertiary hospital. The risk factors for extubation failure and deterioration with further MV were investigated by multivariate logistic regression.
A total of 676 patients were enrolled in the study. Patients with extubation failure had a longer ICU length of stay and a higher mortality rate than patients without extubation failure. An age greater than 65 years, abnormal heart rate, respiratory rate exceeding 20 times/min, arterial pH lower than 7.35, pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio lower than 300 mmHg, mean arterial pressure lower than 70 mmHg, duration of MV longer than 12 hours, and high quick Sequential Organ Failure Assessment (qSOFA) score were independent risk factors for extubation failure. Furthermore, we found that a respiratory rate greater than 20 times/min and a PaO2/fraction of Inspired Oxygen FiO2 ratio less than 300 mmHg were protective factors, while a mean arterial pressure lower than 70 mmHg, arterial pH lower than 7.35, and high qSOFA score were risk factors for deterioration on continued MV.
Since the duration of MV increases the risk of extubation failure, physicians should consider not only the risk of extubation failure but also the risk of deterioration with further MV.
拔管是重症监护病房（ICU）中的关键步骤。在本研究中，我们旨在调查拔管失败以及进一步机械通气（MV）病情恶化的危险因素。
数据收集自一家三级医院的心胸外科ICU。通过多因素逻辑回归分析拔管失败以及进一步MV病情恶化的危险因素。
本研究共纳入676例患者。拔管失败的患者与未拔管失败的患者相比，在ICU的住院时间更长，死亡率更高。年龄大于65岁、心率异常、呼吸频率超过20次/分钟、动脉血pH低于7.35、动脉血氧分压（PaO2）/吸入氧分数（FiO2）比值低于300 mmHg、平均动脉压低于70 mmHg、MV持续时间超过12小时以及序贯器官衰竭评估快速评分（qSOFA）高是拔管失败的独立危险因素。此外，我们发现呼吸频率大于20次/分钟和PaO2/FiO2比值小于300 mmHg是保护因素，而平均动脉压低于70 mmHg、动脉血pH低于7.35以及qSOFA评分高是继续MV病情恶化的危险因素。
由于MV持续时间会增加拔管失败的风险，医生不仅应考虑拔管失败的风险，还应考虑进一步MV病情恶化的风险。
